In the Wake of War: Part 2 - Symptoms or Survival?

The Allamakee County Veterans Services has contracted with Greg Clark, M.A. to provide counseling services to the veterans of Allamakee County since 2007. Clark, a combat-wounded Vietnam Veteran and Licensed Mental Health Counselor, has worked with veterans since 1981. The following is Part 2 of a three-part informational series Clark wishes to share with veterans, their families and the community at large about PTSD (Post Traumatic Stress Disorder) and his counseling services to veterans.

by Greg Clark, M.A.
Licensed Mental Health Counselor

Below I have listed and described each symptom of PTSD (Post Traumatic Stress Disorder), followed with an attempt at illuminating the normalcy of the development of that symptom from a “combat wisdom” perspective. In effect, I invite the reader to consider how the symptoms of PTSD (“here and now” - Post Trauma) were once a healthy way to be (“then and there” - in the combat zone), particularly as relates to the tasks of survival.

1) Avoidance of the memories, or events that might trigger recall of the memories: Here the veteran consciously and/or unconsciously is attempting to keep the painfulness of the memories “at bay.” Isn’t it logical to want to avoid pain? And mightn’t painful feeling and thoughts in the combat zone interfere with the tasks of survival?

2) Daytime intrusive memories, dreams/nightmares or flashbacks: These occur as the by-product of Avoidance (in symptom #1.) Without getting too technical, the mind is programmed to “integrate” our experiences, and this process of integration is accomplished by the mind assessing an experience for where it might be a match or “fit” into our belief system.

This assessing can only be accomplished by looking at (facing) the experience in an evaluative way. So, where the veteran avoids facing the trauma (symptom #1) there can be no assessment of it - and therefore no integration can occur. This leaves the mind’s task of integration unfulfilled and as the mind is programmed to complete its task, it will continue to recall the memory (by way of intrusive memories, nightmares and flashbacks) as if forcing the individual to face the memory for purposes of integration.

These symptoms are, simply put, the mind’s manner of getting the individual to face their reality in order to complete the process of integration. This “recalling” will continue until integration occurs - only by facing the memory. PTSD treatment can help bring this about. “That which you resist, persists”.

3) Blank spots for some of the memory of the traumatic event: This reveals that the magnitude of horror of this event was so great for the individual that they have “blocked it out from retrievable memory.” It was likely too threatening to their Belief Systems about the Self, Others, and/or the World.

4) Negative beliefs/thoughts about the self, others and/or the world: In combat, the veteran was conditioned to expect the worst in order to be prepared to survive it. Thus, their default view of life is to “anticipate the worst.” This playing it safe fosters both mistrust and the need to be in control.

5) Shaming/blaming self or others for the trauma: Sometimes, in the effort to make sense out of something so surreal or incompatible with their beliefs, or that seems so senseless they assign responsibility/guilt, even to themselves, so as to “force” the event to “make some sense” to them. For example, “the world really is safe and predictable, it's just that I screwed up."

This retains the belief of a safe and predictable world intact - but at the expense of others and self-chastisement. Some Survival Guilt may be found here.

6) Anhedonia: the inability to feel joy or pleasure: Not having adaptively integrated their trauma, they live with the intrusive moments (symptom #2) of the returning horror of it, and when not reliving that horror, they live in fear of when it will return. They also live in fear of the possibility of future such horrors now that their reality has revealed such possibilities can and do happen.

They may wonder how others can have so much fun when the veteran has witnessed so much suffering and knows how horrible people can be to one another. They may also be “stuck in Impacted Grief” over their losses - such as their friends, their youth, their innocence, their beliefs, their hopes and their potential: “I coulda’ been ___”, etc.

In combat they were conditioned to suppress their emotions as survival dictates that priority be given to the thinking processes - “don’t worry about what you’re feeling, focus on that which will enhance your chances of survival.” In combat, it is common to numb one’s feelings so as to not be overwhelmed by them, resulting in losing focus on the tasks of surviving.

This numbing results in a narrowing of their range of emotions - keeping them from getting too “down” and depressed about their situation, fears and losses.

But it also prevents them from getting too “up” because they know they need to be mindful that bad things could lie just around the corner. They then return home with this same restricted range of emotions and, thus, a difficulty in experiencing joy.

7) Isolation/Alienation: Feeling as if one doesn’t fit in society anymore: They see their peers who have gone on with families and careers while they were busy trying to survive and cope with what they saw and did. Some may have resentment that they were denied the life that others enjoy. They do not want to re-experience the painfulness of loss, so they don’t risk getting close to others.

Intimacy or socializing also run the risk of others getting to know things about them they may not want others to know – e.g., what they’ve seen or done. Because their experiences were so surreal they may feel that only another veteran could understand their experience so they’ll only open up to another combat veteran.

8) Hyper-Vigilance: Difficulty concentrating/staying focused: They are conditioned to “keep your head on a swivel” to prevent “target fixation” which could lead to missing a real threat. Their mind wanders looking for potential threats, and they are “on guard” to avoid inadvertently running into the threat of associations that might trigger unwanted memories.

They may also be easily startled and ready to “defend themselves.” They have been conditioned to take aggressive action when startled by sudden and/or loud noises they associate with combat - such as fireworks, or even the simplest act of having someone tap them from behind. Instinctive aggression has caused many to regret their actions when startled.

They are easily irritated, especially when things aren’t going as planned or “their way;” “the more in control I am, the safer I can make it for everyone.” They may have difficulties getting to sleep, staying asleep, or getting a restful sleep - their mind continues to wander, they may not want to let their guard down completely, nightmares cause tossing and turning, not uncommonly, they experience night sweats - “I woke up and I was soaking wet.” Many veterans need to have some background noise, like a fan or TV, going all night to drown out the slightest noise that could call them to alarm.

PTSD also has a circularity whereby many of its symptoms promote mistrust and where, in turn, that mistrust fuels some of its symptoms. These are the primary symptoms of PTSD for which I have endeavored to illuminate the normalcy of their development within a combat zone. To restate, combat veterans may exhibit some or none of these symptoms. But where they do, we need to remember the symptoms are normal and to be expected.

For an appointment with Greg Clark, it is not required that the veteran’s counseling needs be military-related. By their service to our country and at least an “other than dishonorable discharge” they have earned the entitlement to his services through Allamakee County Department of Veterans Affairs. They may also qualify for benefits they’re not even aware of.

If you have any questions about veterans’ benefits, see Allamakee County Veterans Services Director Heather Homewood, or if you wish to speak with Greg Clark, contact the Allamakee County Veterans Service Office at 563-568-6135.

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